Case report Shot sequence detection aided by postmortem computed tomography in a case of homicide Patricia M Flach a,b,n , Garyfalia Ampanozi a , Tanja Germerott c , Steffen G Ross a , Astrid Krauskopf a , Michael J Thali a , Michael T Mund a a Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland b Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland c Institute of Forensic Medicine, Medical School Hannover, Hannover, Germany article info Article history: Received 1 November 2012 Received in revised form 21 March 2013 Accepted 22 March 2013 Keywords: Virtopsy Gun shot Homicide PmCT Postmortem Computed tomography Autopsy abstract This study investigated the use of postmortem computed tomography (pmCT) in a homicide victim with three gunshots. This case report illustrates that pmCT enhances the forensic investigation and facilitates dissection of complex regions like the neck and may aid in the determination of a possible chronology of successive shooting. Postmortem imaging should be included as an established standard protocol in any state-of-the-art gunshot injury examination in forensic pathology, as this imaging method may provide more information than autopsy alone. & 2013 Elsevier Ltd. All rights reserved. 1. Introduction The use of 2-dimensional radiography for gunshot wounds is well established in forensic medicine. However, the role of radiology in a forensic examination has expanded during the past decade to include postmortem computed tomography (pmCT), pmCT-angiography (pmCTA), image-guided biopsy and magnetic resonance imaging [1–5]. The virtual autopsy (“Virtopsy”) is particularly advantageous in gunshot victims, as pmCT is a non-invasive technique that aids in the detection and precise spatial localization of foreign bodies such as metallic fragments or projectiles and guides the forensic pathologist during bullet retrieval [6–8]. In addition, 3-dimensional pmCT can be used to document the bullet path(s) by depicting typical gunshot wound fracture patterns, discriminating osseous entry and exit wounds and evaluating any associated tissue damage prior to autopsy [9–14]. Additionally, the shooting direction, number and type of shots (e.g., penetrating, perforating, grazing, or self- or foreign force- inflicted), firing distance and an inference of the weapon and ammunition are of forensic interest. The investigation should also detect the source of immediate incapacitation and the manner and cause of death. This report of a homicide case delineates the feasibility of pmCT prior to autopsy to determine the precise anatomy and maybe even chronology of successive gunshots. 2. Case history A 55-year-old woman was shot by her husband three times in a public place and succumbed to her injuries at the crime scene. 3. External inspection The corpse presented with sparse livor mortis. Shot number 1: A position-dependent blood track was observed at the right ear with a cartilaginous and soft tissue burst of the right earlobe, which was consistent with a perforating shot. A retroauricular longitudinal abrasion was the result of a grazing shot. Shot number 2: Crepitation was detected in the right mandible with palpable soft tissue emphysema in the left midface, neck and thorax. An oval defect (5 mm) with an abraded appearance (1–4 mm) and powder stippling on the skin of the right mandible was compatible with an entry wound, and a larger Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/locate/jofri Journal of Forensic Radiology and Imaging 2212-4780/$ - see front matter & 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jofri.2013.03.045 n Correspondence to: Institute of Legal Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland. Tel.: +41 44 635 5611; fax: +41 44 635 6851. E-mail address: patricia.flach@irm.uzh.ch (P.M. Flach). Journal of Forensic Radiology and Imaging 1 (2013) 68–72